Patterns of agreement among parent, teacher and youth ratings in a referred sample

ObjectiveThe purpose of this study was to investigate the degree of agreement among parents, teachers and adolescents with respect to the Child Behavior Checklist (CBCL), the Teacher's Report Form (TRF), and the Youth Self Report (YSR). In addition we evaluated the suitability of these three forms (CBCL, TRF and YSR) in terms of their contribution to understanding internalizing and externalizing disorders in youths being referred to a child and adolescent unit of a psychiatric care facility.MethodsA total of 611 patients aged 11–18 years (mean age 13.0, SD 1.6) were assessed using the CBCL, the TRF and the YSR.ResultsIntraclass coefficients (ICC) showed low to moderate agreement among informants. Furthermore, the level of agreement was generally less among patients suffering from internalizing disorders than for young patients who displayed externalizing disorders. Logistic regression revealed that the TRF internalizing syndrome scale, the CBCL internalizing syndrome scale and gender were relevant prognostic factors for the occurrence of internalizing disorders in youth. The YSR internalizing syndrome scale, on the other hand, was not a relevant factor among adolescents of a clinical target population. Likewise, only the TRF externalizing syndrome scale, the CBCL externalizing syndrome scale and gender were relevant prognostic factors for the occurrence of externalizing disorders in youth.ConclusionsParticularly the CBCL and TRF are useful instruments in assessing internalizing and externalizing disorders in adolescents referred to a mental health setting.     

Internalizing and externalizing conditions in adolescent anorexia

OBJECTIVE: To identify the prevalence of internalizing and externalizing conditions in referred anorexic adolescents. METHOD: Child Behavior CheckList (CBCL) and Youth Self Report (YSR) were used to assess psychopathology: (a) in the global sample (43 adolescents); (b) in different subtypes of anorexia; (c) considering the timing of admission after the onset of the disease. RESULTS: A high percentage of patients were found in the internalizing clinical range both at CBCL and YSR. Higher mean values were found in full syndromes both at CBCL and YSR, and in the binge-eating subtype only at the YSR. Subjects arrived within the first year of illness showed a less severe psychopathology. CONCLUSIONS: Adolescents with anorexia have high rates of internalizing psychopathology. The less severe psychopathology in adolescents arrived within the first year of illness shed light on discontinuity between anorexia and internalizing condition. On the basis of the psychopathological severity, three types of adolescent anorexia are proposed which could be of interest for therapeutic decisions.     

Cross-Informant Agreement on Child and Adolescent Withdrawn Behavior: A Latent Class Approach

Withdrawn behavior (WB) relates to many developmental outcomes, including pervasive developmental disorders, anxiety, depression, psychosis, personality disorders and suicide. No study has compared the latent profiles of different informants’ reports on WB. This study uses multi-informant latent class analyses (LCA) of the child behavior checklist (CBCL), teacher report form (TRF) and youth self-report (YSR) to examine phenotypic variance in WB. LCA was applied to the CBCL, TRF and YSR of 2,031 youth (ages 6–18); of which 276 children were clinically-referred. A 4-class solution for the CBCL and 3-class solutions for the YSR and TRF were optimal. The CBCL yielded low symptoms, predominantly shy or secretive moderate symptoms, and all symptoms classes. The TRF lacked the moderate—secretive class, and the YSR lacked the moderate—shy class. Agreement was low. LCA shows similar structure of withdrawn behavior across informants but characterizations of moderate WB vary.     

Competence, emotional and behavioural problems in Russian adolescents

Competence, emotional and behavioural problems were examined in 256 school-children, aged 13–17 years, in Novosibirsk, Russia, using the Youth Self-Report (YSR), the Child Behavior Checklist (CBCL) and the Teacher's Report Form (TRF). The internal consistency of syndrome scales for all three instruments was generally adequate. Interrater agreements for the problem scales were higher for girls than for boys in all combinations of informants. These findings are discussed in terms of gender role development. Gender effects on the scales' scores were more numerous and stronger than age. No SES differences were found. Russian children reported more problems than children of other nationalities did. Compared with American children, Russians were lower on competencies and higher on Somatic complaints and self-reported behavioural problems. On competence scales, Russian children in an unselected sample scored themselves lower than American children in a clinical sample. It is supposed that low self-esteem may be the first effect of the unfavourable development in Russian adolescents. Accepted: 7 May 1999     

Informant Agreement in Behavior Ratings for Children with Epilepsy

The purpose of this study was to determine the degree of informant agreement for behavioral ratings of children with epilepsy. Informants completed Achenbach's 1991 scales: parents completed the Child Behavior Checklist (CBCL), teachers completed the Teacher's Report Form (TRF), and youth completed the Youth Self-Report Form of the CBCL (YSR). Analyses included degree of concordance of ratings as a function of informant, child gender, and condition severity (active vs inactive epilepsy). Results indicated that across all four types of raters (mothers, fathers, teachers, and adolescents) there was a similar pattern. Mothers' ratings tended to be the highest and youths' ratings tended to be the lowest across scales. In general, agreement among adult raters was greater than between youth and adults. Mothers and teachers reported more internalizing symptoms than did youth; mother, father, and teacher ratings on externalizing symptoms were not significantly different from each other. There were no significant effects of gender and condition severity on concordance among ratings although there were some interesting trends.     

对立违抗性障碍患儿行为特征的初步研究

目的了解对立违抗性障碍（ODD）患者的行为特征。方法应用Achenbach儿童行为量表（CBCL）、教师报告表（TRF）及青少年自我报告表（YSR）对213例ODD儿童和213名正常儿童（对照组）进行评定和比较。结果（1）CBCL：ODD组的社交情况、学校情况及社会能力总分低于对照组，而退缩、躯体主诉、焦虑／抑郁、社交问题、思维问题、注意问题、违纪行为、攻击性行为、内化性问题、外化性问题和行为问题总分高于对照组（均P〈0．01）。（2）TRF：ODD组的学习努力、行为适当得体、学习效果、快乐、适应能力总分等的评分低于对照组，而退缩、焦虑／抑郁、社交问题、思维问题、注意问题、违纪行为、攻击性行为、内化性、外化性问题评分和行为问题总分高于对照组，差异有统计学意义（P〈0．05—0．01）。（3）YSR：ODD组的焦影抑郁、注意问题、违纪问题、攻击性问题、自我身份、外化性问题评分高于对照组（均P〈0．05和〈0．01）。结论ODD儿童存在更多的行为问题，以攻击、对抗、情绪不稳为主要特征，伴有退缩、焦虑抑郁等内化性问题。     

Agreement between youth-reported and parent-reported psychopathology in a referred sample

Objective  The study examined parent-youth agreement regarding reports on psychopathology among adolescents suffering from psychiatric disorders. Method  A total of 1,718 patients between the age of 11 and 18, as well as their parents, were assessed using the child behavior checklist (CBCL), and the youth self-report (YSR). Results  Poor to low agreement between parent- and adolescent-reported problem behavior on the internalizing scale, the total problem scale and moderate agreement concerning the externalizing scale of the CBCL and the YSR were found. Independent from the amount of psychiatric diagnoses, adolescents reported significantly less behavioral problems than their parents. Concerning externalizing problems, parent-youth disagreement was stronger for patients suffering from comorbid psychiatric disorders, than for adolescents displaying only one psychiatric disorder. Conclusion  In clinically referred children, parents are likely to emphasize the severity of the difficulties, whereas adolescents’ under-report symptoms.     

Predicting internalizing problems in Moroccan immigrant adolescents in the Netherlands

Background With the increasing number of immigrants worldwide, it is essential to have insight into the factors associated with internalizing problems in immigrant youth. However, little research on this subject has been conducted. The aim of the current study is to contribute to the knowledge in this field. Methods Data were obtained from the general population of 11- to 18-year-old Moroccan immigrant adolescents in the Netherlands. Using the Child Behavior Checklist (CBCL), Youth Self-Report (YSR), and Teacher's Report Form (TRF), 415 parent, 376 self-, and 238 teacher reports were available for analysis. Results The data showed relations between internalizing problems and several child (externalizing and chronic health problems), proximal family (paternal and maternal support and parent–child conflict), contextual family (conflicts between parents about parenting and total number of life-events), school/peer (being bored), and migration variables (adolescent's perceived discrimination). Moreover, a modest relation was found between internalizing problems and parental psychopathology. Few associations occurred with the global family factor (e.g., family educational level). Several relations between the predictors and YSR internalizing proved to be gender-specific. Conclusions Our results suggested that the child, school/peer, and proximal family factors are the most important in predicting the development of internalizing problems in Moroccan immigrant adolescents. The impact of the migration factor was small.     

Agreement between parent- and self-reports of Algerian adolescents' behavioral and emotional problems

The present study examined agreement between scores obtained from self-reports of behavioral and emotional problems obtained from 513 Algerian adolescents on the Youth Self-Report (YSR) with scores obtained from reports provided by their parents on the Child Behavior Checklist (CBCL). The correlations between self- and parent-report were larger than those observed in many other cultures (e.g., intraclass correlation coefficient = 0.60 and Pearson r = 0.65 for Total Problems). On the whole, cross-informant agreement did not vary significantly as a function of problem type, identity of the parental informant, gender and age of the adolescent. Similar to all studied cultures, adolescents on average reported more problems than their parents reported about them, but the discrepancies were smaller than in all previous societies. Mean YSR/CBCL score discrepancies indicated higher YSR scores for several scales, but variability across dyads was large, and many dyads showed the opposite pattern.     

Behavioral and emotional problems in Chinese adolescents: parent and teacher reports.

OBJECTIVE: This study examined behavioral and emotional problems in Chinese adolescents. METHOD: A sample of 1,694 adolescents aged 12 to 16 years participated in this study in 1997. Parents completed the Child Behavior Checklist (CBCL), and teachers completed the Teacher's Report Form (TRF). RESULTS: For both parent and teacher reports, internalizing syndromes were scored higher in girls and externalizing syndromes were scored higher in boys. Scores on most of the CBCL and TRF subscales were higher for the older adolescents. The overall prevalence rates of parent- and teacher-reported behavioral problems were 23.1% and 19.2%, respectively. The eight cross-informant syndromes were highly comorbid, with a significant association across syndromes (mean odds ratio = 16.1 for CBCL and 22.5 for TRF). Correlations between parent and teacher reports were 0.51 for eight subscales and 0.68 for Total Problems. CONCLUSIONS: These findings demonstrate that behavioral and emotional problems tend to increase with age and cluster in the same individuals. The prevalence rates of behavioral problems in Chinese adolescents are comparable to those reported in Western countries. In contrast to findings for Western samples, parent reports of behavioral problems were highly correlated with teacher reports.     

Prevalence of psychopathology in children of a bipolar parent

OBJECTIVE: To determine psychopathology in adolescent children of a bipolar parent living in the Netherlands, using multiple sources of information (self-, parent, and teacher reports). METHOD: Problem behavior in 140 offspring (aged 12-21 years) of 86 bipolar parents was assessed with the Child Behavior Checklist (CBCL), the Teacher's Report Form (TRF), and the Youth Self-Report (YSR) between 1997 and 1999. All adolescents, bipolar parents, and their available spouses were interviewed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). RESULTS: Higher problem scores were found for 8 of the 11 CBCL scales for girls and 4 of the 11 CBCL scales for boys, compared with a Dutch normative sample, and 1 Young Adult Self-Report (YASR) scale for girls compared with an American normative sample. Lower problem scores were found on 4 YSR and 4 YASR scales for boys, 1 TRF scale for girls, and 1 TRF scale for boys. The prevalence of current DSM-IV diagnoses in the offspring was 29% and of life-time DSM-IV diagnoses, 44%. CONCLUSIONS: The prevalence of problem behavior and DSM-IV diagnoses found in our sample did not support the notion that the level of psychopathology in children aged 12 to 21 years of bipolar parents is highly elevated. This study, similar to prior studies, suffers from lack of information on the representativeness of the sample and a rather low response rate.     

Poor peer relations predict parent- and self-reported behavioral and emotional problems of adolescents with gender dysphoria: a cross-national,cross-clinic comparative analysis

This study is the third in a series to examine behavioral and emotional problems in children and adolescents with gender dysphoria in a comparative analysis between two clinics in Toronto, Ontario, Canada and Amsterdam, the Netherlands. In the present study, we report Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) data on adolescents assessed in the Toronto clinic (n = 177) and the Amsterdam clinic (n = 139). On the CBCL and the YSR, we found that the percentage of adolescents with clinical range behavioral and emotional problems was higher when compared to the non-referred standardization samples but similar to the referred adolescents. On both the CBCL and the YSR, the Toronto adolescents had a significantly higher Total Problem score than the Amsterdam adolescents. Like our earlier studies of CBCL data of children and Teacher’s Report Form data of children and adolescents, a measure of poor peer relations was the strongest predictor of CBCL and YSR behavioral and emotional problems in gender dysphoric adolescents.     

Symptoms defined by parents' and teachers' ratings in attention-deficit hyperactivity disorder: changes with age.

OBJECTIVE: To determine whether Child Behavior Checklist/4-18 (CBCL) and Teacher Report Form (TRF) scores of children and adolescents with a first-time diagnosis of attention-deficit hyperactivity disorder (ADHD) are different and whether there is a similar difference in normal control subjects. METHOD: We analyzed the CBCL and TRF scores of 146 patients (124 boys and 22 girls, aged 6 to 18 years; mean age 11.0 years, SD 3.6). We analyzed the same scores for 274 age and sex-matched control subjects recruited from a nationally representative sample. RESULTS: Subjects with ADHD had significantly higher CBCL and TRF scores than control subjects. Age was significantly correlated with scores on the CBCL and TRF subscales Social Withdrawal, Somatic Complaints, and Internalization Problems; with scores on the CBCL subscale Attention Problems; and with scores on the TRF subscale Anxiety-Depression. In the group with ADHD, age was negatively correlated with scores on the CBCL and TRF subscale Externalizing Problems and with scores on the TRF subscale Aggressive Behavior. In the control group, the only significant correlation was between age and the CBCL subscale Somatic Complaints score. CONCLUSIONS: These results indicate that underdiagnosis of ADHD in childhood may cause the emergence of greater internalization problems in adolescence.     

Denial of symptoms and psychopathology in adolescent anorexia nervosa

OBJECTIVE: To evaluate the psychopathological status and denial of symptoms in a sample of 38 consecutively admitted adolescents with anorexia nervosa (AN). METHOD: The Schedule for Affective Disorders and Schizophrenia for School-Aged Children was used to determine the categorical diagnosis of eating disorder. The anorexic adolescents completed the EAT-40 (Eating Attitude Test) and, on the basis of its score, the sample was dichotomized in a false-negative group (FNG) scoring under 30 and a positive group (PG) scoring over 30. We compared these two subgroups in terms of clinical variables (age of onset and admission, duration of illness prior to admission, diagnosis, BMI) and psychopathology assessed by the CBCL (Child Behaviour Checklist) and the YSR (Youth Self-Report). In order to evaluate the possible role of diagnosis and BMI on the EAT score we also dichotomized the sample with respect to the diagnosis (full vs. partial AN) and to the mean female BMI (< or = 15 vs. > 15). RESULTS: A significant difference was found in terms of duration of illness prior to admission, which was briefer in the FNG. Higher CBCL and YSR values were found in the PG with significant differences in terms of YSR internalizing symptoms. A large amount of significantly positive Pearson's correlations were found between the CBCL and YSR values in the FNG. No significant Pearson's correlations were found between EAT, BMI and diagnosis. CONCLUSIONS: The lower CBCL and YSR values in the FNG seem to point out a tendency of this group to deny anxiety and depression as well as an eating pathology; the longer duration of illness prior to admission in the PG seems to support the hypothesis that the PG may be considered to be not so much more disturbed as more aware of its eating attitudes and psychopathology. The nature of denial in anorexic adolescents is discussed.     

Subscales scores of the Lithuanian version of CBCL--preliminary data on the emotional and behavioural problems in childhood and adolescence

This study set out to investigate some psychometric properties of the Lithuanian version of CBCL for providing the preliminary data on the emotional and behavioural problems in Lithuanian children taking factors such as gender, age, SES and family composition into account. The CBCL was completed by parents of 7- to 11- and 12- to 14-year-old school children (N = 1296) drawn from the urban and suburban population. Younger boys scored higher than girls on externalizing problems and total problems scores, and older girls scored higher on internalizing problems. Younger children scored higher than the older children on total problems and externalizing problems scores. The comparisons with the US sample indicated that the levels of problem behaviour in 7- to 14-year-old children are similar to those found in the US. Lithuanian children had higher total problem scores; however, the effect sizes for other scales, except the attention problems scale and the somatic complaints scale, were very small. Similar to other studies, we found significant SES effects on total problem scores. Problem scores were highest for the lowest SES children. In general, this study supports previous findings concerning CBCL: similarities in emotional and behavioural problems outweigh differences in cross-cultural studies based on CBCL. Accepted: 14 January 2003 Correspondence to R. Zukauskiene     

Behaviour problems in children with dyslexia

The association between behaviour problems and dyslexia was assessed in a population sample of 10- to 12-year-old children. Twenty-five dyslexic children and a matched control group were recruited through a screening in primary schools in the city of Bergen, Norway. For the assessment of behaviour problems the Child Behavior Checklist (CBCL), Teacher Self Report (TRF), and Youth Self Report (YSR) were filled out by parents, teachers, and children, respectively. Information on health and developmental factors were obtained from parents on a separate questionnaire designed for the study. The dyslexic group had significantly more behaviour problems than the control group according to both the CBCL and the TRF. On the YSR there was no significant difference between the groups. Dyslexic children had higher CBCL and TRF scores on the Total Behaviour Problem scale, the Internalizing and Externalizing subdomains, and the Attention problem subscale. The groups differed in social background, prenatal risk factors, birth weight, preschool language problems, and IQ, but these variables showed no relationship to the level of behaviour problems in the present sample. We conclude that pre-adolescent dyslexic children show a wide range of behaviour problems that cannot be attributed to social or developmental background variables.     

Screening in early childhood for risk of later mental health problems: a longitudinal study

Depression in childhood or adolescence is associated with increased rates of depression in adulthood. Does this justify efforts to detect (and treat) those with symptoms of depression in early childhood or adolescence? The aim of this study was to determine how well symptoms of anxiety/depression (A-D) in early childhood and adolescence predict adult mental health. The study sample is taken from a population-based prospective birth cohort study. Of the 8556 mothers initially approached to participate 8458 agreed, of whom 7223 mothers gave birth to a live singleton baby. Children were screened using modified Child Behaviour Checklist (CBCL) scales for internalizing and total problems (T-P) at age 5 and the CBCL and Youth Self Report (YSR) A-D subscale and T-P scale at age 14. At age 21, a sub-sample of 2563 young adults in this cohort were administered the CIDI-Auto. Results indicated that screening at age 5 would detect few later cases of significant mental ill-health. Using a cut-point of 20% for internalizing at child age 5 years the CBCL had sensitivities of only 25% and 18% for major depression and anxiety disorders at 21 years, respectively. At age 14, the YSR generally performed a little better than the CBCL as a screening instrument, but neither performed at a satisfactory level. Of the children who were categorised as having YSR A-D at 14 years 30% and 37% met DSM-IV criteria for major depression and anxiety disorders, respectively, at age 21. Our findings challenge an existing movement encouraging the detection and treatment of those with symptoms of mental illness in early childhood.     

Psychosocial symptoms in children of hemodialysis patients

Serious somatic illness in a parent represents a risk factor for psychosocial abnormalities in children. In a cross sectional study 24 families with a parent undergoing hemodialysis and at least one child living at home were examined. Patients, their spouses, children up from age 11 as well as the nephrologists in charge of the dialysis treatment were interrogated. In the parental perspective of a symptom checklist (CBCL), the children on average did not have higher scores for psychosocial abnormalities than a normative sample. In the self-reporting perspective (YSR), however, the adolescents averaged clinically abnormal scores. The discrepancy between the parental and the children's self-reporting scores were significant, which indicates an underestimation of children's psychological stress by both parents. Case analysis revealed a concentration of abnormalities within a quarter of the sample. This smaller subgroup showed clinically relevant scores in psychosocial abnormalities in the parental perspective, too. Younger children and children with additional life stressors had higher scores in psychosocial abnormalities. Futhermore, children's problems were correlated with depressive symptoms in one or both parents, which indicates an increased risk for children's psychological maladaptation in cases of depressive maladjustment to the illness in the ill parent or his spouse. It is concluded that children at special risk should be identified as early as possible. When problems are detected, counselling support should be offered to affected families.     

Self-reports on mental health problems of youth with moderate to borderline intellectual disabilities

OBJECTIVE: To determine the extent to which the Youth Self-Report (YSR) can be used to assess emotional and behavioral problems in adolescents with intellectual disabilities (IDs). METHOD: In 2003, 281 11- to 18-year-olds with IDs (IQ > or =48) completed the YSR in an interview, and in 1993, 1,047 non-ID adolescents completed the YSR themselves. Parents completed the Child Behavior Checklist (CBCL). The ID sample was split into lower (IQ 48-69) and higher (IQ > or =70) IQ groups. Cronbach's alpha values of the YSR scales and (intraclass) correlation coefficients between and within YSR and CBCL scale scores were calculated to determine parent-adolescent agreement and YSR construct validity, which were compared between samples. Mean YSR scale scores were compared between adolescents with ID with and without psychiatric symptoms. RESULTS: Cronbach's alpha, parent-adolescent agreement, and indications of construct validity were about similar in all samples, although discriminant validity was somewhat weaker in the lower IQ group. Mean scale scores were 1.5 to 2.0 times higher for ID adolescents with psychiatric symptoms. CONCLUSIONS: The YSR seems applicable in youth with an IQ > or =48. Further research is needed to refine and confirm these findings and the factor structure of the YSR in adolescents with ID and to differentiate between adolescents with moderate and mild IDs.     

Ethnic variation in symptoms and response to risperidone in youths with schizophrenia-spectrum disorders

BACKGROUND: Evaluation of symptom presentation and antipsychotic response based on ethnicity in children and adolescents with schizophrenia is limited. The purpose of this naturalistic, retrospective database study was to compare symptom presentation of children and adolescents of different ethnicities with schizophrenia-spectrum disorders, and response to risperidone. METHOD: African-American (n = 38), Caucasian (n = 30), or Hispanic (n = 37) youths started on risperidone were eligible. Child Behavior Checklist (CBCL) total, internalizing, and externalizing scores were evaluated at baseline, 90 days, 1 year, and 2 year intervals. RESULTS: At baseline, Hispanic patients had lower CBCL externalizing scores than African-Americans or Caucasians. African-Americans showed significant differences in CBCL total, internalizing, and externalizing scores at 90 days compared to baseline. Hispanics showed improvement in CBCL internalizing scores over the 2 year period. No significant improvements were observed in Caucasians. African-American patients had significantly lower CBCL total at 90 days compared to Hispanic patients. No significant difference existed in 2 year hospitalization rates between groups. CONCLUSIONS: These findings suggest that ethnicity may play a role in symptom presentation and treatment response to risperidone for children and adolescents with schizophrenia-spectrum disorders. Future studies in children and adolescents are necessary to examine ethnospecific differences in antipsychotic use and treatment response.